Vulvar carcinoma: The price of less radical surgery
The objective of this study was to determine whether modifications in the treatment of patients with vulvar carcinoma influence the rates of recurrence and survival. Between 1982 and 1997, 253 patients with T1 and T2 invasive squamous cell carcinoma of the vulva were treated by essentially the same...
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| Veröffentlicht in: | Cancer 2002-12, Vol.95 (11), p.2331-2338 |
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| creator | DE HULLU, Joanne A HOLLEMA, Harry LOLKEMA, Sietske BOEZEN, Marike BOONSTRA, Henk BURGER, Matthe P. M AALDERS, Jan G MOURITS, Marian J. E VAN DER ZEE, Ate G. J |
| description | The objective of this study was to determine whether modifications in the treatment of patients with vulvar carcinoma influence the rates of recurrence and survival.
Between 1982 and 1997, 253 patients with T1 and T2 invasive squamous cell carcinoma of the vulva were treated by essentially the same team of gynecologic oncologists, and 168 patients (Group I) underwent radical vulvectomy with en bloc inguinofemoral lymphadenectomy. Standard therapy was changed in 1993, and 85 patients (Group II) underwent wide local excision with inguinofemoral lymphadenectomy through separate incisions. The rates of recurrence and survival were compared between both groups.
In Group II, the overall recurrence rate (33.3%) within 4 years was increased compared with Group I (19.9%; P = 0.03). In Group II, 5 of 79 patients (6.3%) developed fatal groin or skin bridge recurrences compared with 2 of 159 patients (1.3%) in Group I (P = 0.029); this did not result in a difference in overall survival. In Group II, 40 of 79 patients had tumor free margins measuring 8 mm, resulting in no local recurrences (P = 0.002).
The current study showed that fatal recurrences in either the groin or the skin bridge were more frequent after wide local excision and inguinofemoral lymphadenectomy through separate incisions; however, probably due to lack of power, this did not result in shorter survival. In 40 of 79 patients, the histologic margins measured |
| doi_str_mv | 10.1002/cncr.10969 |
| format | Article |
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Between 1982 and 1997, 253 patients with T1 and T2 invasive squamous cell carcinoma of the vulva were treated by essentially the same team of gynecologic oncologists, and 168 patients (Group I) underwent radical vulvectomy with en bloc inguinofemoral lymphadenectomy. Standard therapy was changed in 1993, and 85 patients (Group II) underwent wide local excision with inguinofemoral lymphadenectomy through separate incisions. The rates of recurrence and survival were compared between both groups.
In Group II, the overall recurrence rate (33.3%) within 4 years was increased compared with Group I (19.9%; P = 0.03). In Group II, 5 of 79 patients (6.3%) developed fatal groin or skin bridge recurrences compared with 2 of 159 patients (1.3%) in Group I (P = 0.029); this did not result in a difference in overall survival. In Group II, 40 of 79 patients had tumor free margins measuring <or= 8 mm, resulting in 9 local recurrences; whereas 39 of 79 patients had tumor free margins measuring > 8 mm, resulting in no local recurrences (P = 0.002).
The current study showed that fatal recurrences in either the groin or the skin bridge were more frequent after wide local excision and inguinofemoral lymphadenectomy through separate incisions; however, probably due to lack of power, this did not result in shorter survival. In 40 of 79 patients, the histologic margins measured <or= 8 mm, resulting in a high risk of local recurrences. Therefore, the authors recommend obtaining surgical margins of 2 cm for the local treatment of patients with vulvar carcinoma.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.10969</identifier><identifier>PMID: 12436439</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>New York, NY: Wiley-Liss</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Carcinoma - pathology ; Carcinoma - surgery ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Medical sciences ; Middle Aged ; Mortality ; Neoplasm Recurrence, Local ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the genital tract and mammary gland ; Treatment Outcome ; Vulvar Neoplasms - pathology ; Vulvar Neoplasms - surgery</subject><ispartof>Cancer, 2002-12, Vol.95 (11), p.2331-2338</ispartof><rights>2003 INIST-CNRS</rights><rights>Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10969</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c272t-7e2b356cc7bd2cd6d2b0980509c9dcf55a10def6f0b5f80d593dcfc315af94753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14039221$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12436439$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DE HULLU, Joanne A</creatorcontrib><creatorcontrib>HOLLEMA, Harry</creatorcontrib><creatorcontrib>LOLKEMA, Sietske</creatorcontrib><creatorcontrib>BOEZEN, Marike</creatorcontrib><creatorcontrib>BOONSTRA, Henk</creatorcontrib><creatorcontrib>BURGER, Matthe P. M</creatorcontrib><creatorcontrib>AALDERS, Jan G</creatorcontrib><creatorcontrib>MOURITS, Marian J. E</creatorcontrib><creatorcontrib>VAN DER ZEE, Ate G. J</creatorcontrib><title>Vulvar carcinoma: The price of less radical surgery</title><title>Cancer</title><addtitle>Cancer</addtitle><description>The objective of this study was to determine whether modifications in the treatment of patients with vulvar carcinoma influence the rates of recurrence and survival.
Between 1982 and 1997, 253 patients with T1 and T2 invasive squamous cell carcinoma of the vulva were treated by essentially the same team of gynecologic oncologists, and 168 patients (Group I) underwent radical vulvectomy with en bloc inguinofemoral lymphadenectomy. Standard therapy was changed in 1993, and 85 patients (Group II) underwent wide local excision with inguinofemoral lymphadenectomy through separate incisions. The rates of recurrence and survival were compared between both groups.
In Group II, the overall recurrence rate (33.3%) within 4 years was increased compared with Group I (19.9%; P = 0.03). In Group II, 5 of 79 patients (6.3%) developed fatal groin or skin bridge recurrences compared with 2 of 159 patients (1.3%) in Group I (P = 0.029); this did not result in a difference in overall survival. In Group II, 40 of 79 patients had tumor free margins measuring <or= 8 mm, resulting in 9 local recurrences; whereas 39 of 79 patients had tumor free margins measuring > 8 mm, resulting in no local recurrences (P = 0.002).
The current study showed that fatal recurrences in either the groin or the skin bridge were more frequent after wide local excision and inguinofemoral lymphadenectomy through separate incisions; however, probably due to lack of power, this did not result in shorter survival. In 40 of 79 patients, the histologic margins measured <or= 8 mm, resulting in a high risk of local recurrences. Therefore, the authors recommend obtaining surgical margins of 2 cm for the local treatment of patients with vulvar carcinoma.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Carcinoma - pathology</subject><subject>Carcinoma - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Lymph Node Excision</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neoplasm Recurrence, Local</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the genital tract and mammary gland</subject><subject>Treatment Outcome</subject><subject>Vulvar Neoplasms - pathology</subject><subject>Vulvar Neoplasms - surgery</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkMtKAzEUhoMotlY3PoDMRhfC6EkyyUzcSfEGBTdV3A2Zk0RH5lKTjtC3N7UDXZ0LHz_nfIScU7ihAOwWO_SxU1IdkGmseQo0Y4dkCgBFKjL-MSEnIXzHMWeCH5MJZRmXGVdTwt-H5lf7BLXHuutbfZcsv2yy8jXapHdJY0NIvDY16iYJg_-0fnNKjpxugj0b64y8PT4s58_p4vXpZX6_SJHlbJ3mllVcSMS8MgyNNKwCVYAAhcqgE0JTMNZJB5VwBRiheFwjp0I7leWCz8jVLnfl-5_BhnXZ1gFt0-jO9kMocyYLySSP4PUORN-H4K0r4_2t9puSQrlVVG4Vlf-KInwxpg5Va80eHZ1E4HIEdIhfO687rMOey4Arxij_AxmYbi8</recordid><startdate>20021201</startdate><enddate>20021201</enddate><creator>DE HULLU, Joanne A</creator><creator>HOLLEMA, Harry</creator><creator>LOLKEMA, Sietske</creator><creator>BOEZEN, Marike</creator><creator>BOONSTRA, Henk</creator><creator>BURGER, Matthe P. M</creator><creator>AALDERS, Jan G</creator><creator>MOURITS, Marian J. E</creator><creator>VAN DER ZEE, Ate G. J</creator><general>Wiley-Liss</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20021201</creationdate><title>Vulvar carcinoma: The price of less radical surgery</title><author>DE HULLU, Joanne A ; HOLLEMA, Harry ; LOLKEMA, Sietske ; BOEZEN, Marike ; BOONSTRA, Henk ; BURGER, Matthe P. M ; AALDERS, Jan G ; MOURITS, Marian J. E ; VAN DER ZEE, Ate G. J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c272t-7e2b356cc7bd2cd6d2b0980509c9dcf55a10def6f0b5f80d593dcfc315af94753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Carcinoma - pathology</topic><topic>Carcinoma - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Lymph Node Excision</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neoplasm Recurrence, Local</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the genital tract and mammary gland</topic><topic>Treatment Outcome</topic><topic>Vulvar Neoplasms - pathology</topic><topic>Vulvar Neoplasms - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DE HULLU, Joanne A</creatorcontrib><creatorcontrib>HOLLEMA, Harry</creatorcontrib><creatorcontrib>LOLKEMA, Sietske</creatorcontrib><creatorcontrib>BOEZEN, Marike</creatorcontrib><creatorcontrib>BOONSTRA, Henk</creatorcontrib><creatorcontrib>BURGER, Matthe P. M</creatorcontrib><creatorcontrib>AALDERS, Jan G</creatorcontrib><creatorcontrib>MOURITS, Marian J. E</creatorcontrib><creatorcontrib>VAN DER ZEE, Ate G. 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J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vulvar carcinoma: The price of less radical surgery</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2002-12-01</date><risdate>2002</risdate><volume>95</volume><issue>11</issue><spage>2331</spage><epage>2338</epage><pages>2331-2338</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>The objective of this study was to determine whether modifications in the treatment of patients with vulvar carcinoma influence the rates of recurrence and survival.
Between 1982 and 1997, 253 patients with T1 and T2 invasive squamous cell carcinoma of the vulva were treated by essentially the same team of gynecologic oncologists, and 168 patients (Group I) underwent radical vulvectomy with en bloc inguinofemoral lymphadenectomy. Standard therapy was changed in 1993, and 85 patients (Group II) underwent wide local excision with inguinofemoral lymphadenectomy through separate incisions. The rates of recurrence and survival were compared between both groups.
In Group II, the overall recurrence rate (33.3%) within 4 years was increased compared with Group I (19.9%; P = 0.03). In Group II, 5 of 79 patients (6.3%) developed fatal groin or skin bridge recurrences compared with 2 of 159 patients (1.3%) in Group I (P = 0.029); this did not result in a difference in overall survival. In Group II, 40 of 79 patients had tumor free margins measuring <or= 8 mm, resulting in 9 local recurrences; whereas 39 of 79 patients had tumor free margins measuring > 8 mm, resulting in no local recurrences (P = 0.002).
The current study showed that fatal recurrences in either the groin or the skin bridge were more frequent after wide local excision and inguinofemoral lymphadenectomy through separate incisions; however, probably due to lack of power, this did not result in shorter survival. In 40 of 79 patients, the histologic margins measured <or= 8 mm, resulting in a high risk of local recurrences. Therefore, the authors recommend obtaining surgical margins of 2 cm for the local treatment of patients with vulvar carcinoma.</abstract><cop>New York, NY</cop><pub>Wiley-Liss</pub><pmid>12436439</pmid><doi>10.1002/cncr.10969</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals; Wiley Online Library (Open Access Collection); Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Carcinoma - pathology Carcinoma - surgery Female Follow-Up Studies Humans Lymph Node Excision Medical sciences Middle Aged Mortality Neoplasm Recurrence, Local Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the genital tract and mammary gland Treatment Outcome Vulvar Neoplasms - pathology Vulvar Neoplasms - surgery |
| title | Vulvar carcinoma: The price of less radical surgery |
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